As coronavirus infections reach new statewide highs and the beds of hospitals fill with COVID-19 patients, a “glimmer of hope” has arrived in North Carolina nursing homes.
Pharmacists and other health care workers have started vaccinating long-term care workers and residents.
It’s a moment that nursing home owner Mack McKeithan has been waiting for. Last week, he was the first to roll up his sleeve to get the Moderna coronavirus vaccine. He said he wanted to set the example.
“We have encouraged our staff to take it, but we can also understand all of the paranoia that’s out there and why,” said McKeithan, who owns Fair Haven of Forest City in Rutherford County. “We can’t force them to do it.”
Vaccination teams from CVS and Walgreens are traveling throughout the state to inoculate residents and staff at long-term care facilities, guided by the federal government. Each location will be visited three times, roughly once per month, until all who want the vaccine receive a series of two shots. Research indicates the Moderna vaccine, like others on the market, is around 95% effective if both shots are taken.
However, far fewer people are getting vaccinated than officials had hoped, said Dr. Mandy Cohen, secretary for the N.C. Department of Health and Human Services. Last week she said she has anecdotal reports of around half of workers in long-term care refusing the vaccine.
Hotbed for deadly disease spread
The low vaccination rate worries Lauren Zingraff, executive director for the nonprofit Friends of Residents in Long-Term Care.
“The reason COVID-19 has been as catastrophic and deadly as it has been in long-term care is because of the spread of the virus due to staff spreading it,” Zingraff said. “Many staff don’t know they have it.”
In North Carolina, three out of every five people who have died of COVID-19 since the start of the pandemic are over age 75. Nearly half of the state’s deaths are people in long-term care, such as a skilled nursing facility or adult care home.
People with the virus can have mild symptoms, similar to a cold or flu, or they can face dire health consequences that last for weeks or even months. And then some people don’t have any symptoms at all, but still spread the virus. These asymptomatic carriers of COVID-19 worry Zingraff.
“The reason it is a wildfire (in nursing homes) is because it is coming from the staff,” she said. “The only way residents can be protected is if the staff are getting the vaccine.”
As of Monday, DHHS reported that 7,578 North Carolinians are confirmed to have died from the virus, with nearly 375,000 Americans dead in less than a year, according to Johns Hopkins University.
Of the 165,900 doses allocated for the state’s long-term care residents and staff, nearly 24,000, or 14.5%, of the doses have been used.
In a statement, pharmacy giant CVS said it can take time to administer the vaccine to people in nursing homes. Not everyone can come to a central location to get vaccinated, which requires in-room visits. One-in-three nursing homes in North Carolina have fewer than 100 beds, spreading out the locations of people needing the vaccine. CVS workers will travel to 899 nursing homes and other long-term care facilities before the end of January to administer the first of two shots.
“Despite these challenges, we remain on schedule, and the number of vaccines we administer will continue to rise as more facilities are activated by the states,” according to a statement from CVS Pharmacy.
Race against time
Currently, more than 500 nursing homes and other long-term care facilities have active COVID-19 outbreaks, and with more than 10,000 people in North Carolina testing positive for COVID-19 for multiple days last week, vaccinating this most vulnerable population is a race against time.
To Ester Amy Fischer, the first dose for her 83-year-old mother in a memory care unit in Orange County will come on Jan. 26, which to her seems awfully far away. She was already concerned before she learned her mother had recently tested positive for COVID-19. Each day’s delay in receiving the vaccine can mean thousands or tens of thousands more North Carolinians becoming infected.
“That is why I was so upset about them not getting the vaccine in time,” Fischer said. “Now it is too late for my mom, but not for others.”
Earlier this month, CVS pharmacist Swati Patel was vaccinating residents and staffers at Fair Haven of Forest City. The prior week she had been in Avery and Mitchell counties at two other homes to set up vaccination clinics for staff and residents.
Overall, Patel said, vaccinations are going relatively smoothly, with her pharmacy receiving regular vaccine shipments. She reported no shortages but said fewer people are getting vaccinated than had been planned.
“I think they’re just scared that it’s going to have long-term side effects, or even side effects in general, just because it was approved so quickly,” Patel said. “So, a lot of people are refusing it.”
In December, she said, staffers held one clinic prepared to administer 250 doses of the Moderna coronavirus vaccines.
“We only administered about 50,” she said.
Those who do opt for the vaccine are relieved that an end is in sight to a pandemic that has shuttered them away from visiting loved ones for nearly a year.
“A lot of people that I’ve given the vaccine to, they’re just really thankful that we finally have a vaccine,” Patel said. “A lot of people say it doesn’t hurt.”
Patel and others who are vaccinating in long-term care will return to nursing homes in 28 days, and then a third time 28 days after that. She and McKeithan said they hoped more staffers will elect to get their first dose in the second visit, after they see how their co-workers and residents fare from the visit last week.
Vaccine hesitancy
It’s too early to tell whether the vaccine refusal rate will remain high. Some nursing home operators are encouraging workers to get vaccinated at different times to minimize absences in the rare occurrence of an adverse reaction, said Dr. Susan Kansagra with DHHS.
“Just in case there are some of those minor side effects, which we know that can occur, doses are staggered in such a way that not all staff are experiencing that at the same time,” Kansagra said last week.
Staff members who were not vaccinated in the first round may also be waiting to see how colleagues react to the vaccine before deciding to get the shot themselves, she said.
“That is one of the reasons that we expect there will be higher uptake by the time the second clinic comes around,” Kansagra said.
Currently, visits to people in nursing homes are restricted. For now, only compassionate care visits, such as when someone is nearing the end of life, are allowed indoors. Some long-term care homes are also allowing outdoor visitation as long as everyone wears masks.
When asked if the state would have to continue to restrict nursing home visits if too few people opted for the vaccine, Kansagra said DHHS intends to follow guidance from the federal Centers for Disease Control and Prevention, as well as the Centers for Medicare and Medicaid Services. So far neither agency has issued any guidance.
Kansagra said the department is aware of vaccine hesitancy among long-term care workers and is working to get accurate information to those workers so they can make informed decisions.
As for McKeithan, he’s grateful that the vaccine is finally here.
“It’s been a terribly stressful time for us, and residents and families,” McKeithan said. “This is the first glimmer of hope that we have seen, and I’m just excited that it’s here.”
He said the only way we can return to a normal life is if people get vaccinated.
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If vaccine hesitancy becomes rampant among those in Tier 1, I’m happy to take their place. No reason to delay others among the herd not as hesitant to resume something that resembles normal life with a little more confidence it won’t lead to a death sentence.